Professional Documents
Culture Documents
COMPETENCIES:
(TO KNOW OR BE ABLE TO:)
1. Give examples of techniques that can be used to promote independence and respect a
persons preferences (for example, at mealtimes).
2. Identify resources to identify an individuals mealtime needs.
3. Identify characteristics of people at risk for choking.
4. Identify choking prevention measures a DCW can use during mealtime.
5. Give examples of techniques that can be used to preserve dignity and privacy while
providing personal care.
6. List risk factors for skin breakdown.
7. Explain the importance of repositioning and list techniques for preventing skin damage
and pressure ulcers.
8. Identify and describe common assistive devices, including gait belt, walkers and
wheelchairs.
9. Explain the importance of proper transfer skills and the safe use of assistive devices.
10. Identify issues related to providing assistance with bathing and using the bathroom.
11. Describe and role-play techniques for positioning and transferring a person.
a. Use of gait belt.
b. Assistance with ambulation (with/without assistive devices).
c. Techniques for positioning a person in bed.
d. Techniques for positioning a person in a wheelchair.
e. Transfer in and out of a wheelchair (with or without assistive devices).
f. Transfer out of bed (sofa).
12. Simulate/role-play or describe assistance with ADLs.
a. Assistance with dressing.
b. Assistance with meals (total assistance/feeding, and prompting, hand-over-hand
assistance).
c. Assistance with brushing teeth.
KEY TERMS:
Activities of daily living (ADL)
Ambulation
Assistive device
Choking
Contracture
Gait belt
Grab bar
Incontinence
Pressure sore (ulcer)
Range of motion exercises
Skin integrity
Transfer, transferring
Walker
Wheelchair
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A. INTRODUCTION
1. Activities of Daily Living (ADLs)
ADLs are considered a persons basic, self-care tasks. They include the ability to:
a.
b.
c.
d.
e.
Dress
Eat
Walk and transfer
Use the restroom (toilet)
Take care of hygiene needs (e.g., bathing, grooming)
In addition, there are the Instrumental Activities of Daily Living (IADLs). These activities are
important for the individual to function in the community:
a.
b.
c.
d.
e.
Shop
Keep house (clean, do laundry)
Manage personal finances
Prepare food
Transport (e.g., driving)
This chapter focuses on the personal care needs (the ADLs) and how to provide assistance to
meet those needs. Assistance with some of the IADLs (housekeeping, food preparation) is
addressed in the Fundamentals course book.
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B. MEAL ASSISTANCE
Direct Care Workers may help individuals at mealtimes. Whenever possible, the individual
should eat with a minimum of assistance. If needed, adaptive equipment should be available
to the person to encourage self-feeding. Feed a person only if he/she is unable to do so.
The individual should be sitting with his/her head elevated to prevent choking.
Use clock description for a person with a vision impairment (e.g., meat is at 12:00;
salad is at 4:00, etc.).
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Supplies
Spoon and/or fork, napkin, bowl or plate, clothing protector, cup.
Food items.
Description of Procedure
1. Maintain dignity and safety of at all times.
2. Check support plan (risk assessment) or with supervisor to determine if choking
hazard exists and to verify the consistency of food required. Check if any foods are
prohibited due to allergy or choking hazard.
3. Ensure that you cut up meat, open cartons, butter bread, etc. if that type of
assistance is needed.
4. Sit next to the individual at eye level.
5. Ensure that the individual is sitting with his/her head elevated to prevent choking.
6. Provide ONLY the amount of assistance that is necessary (graduated guidance, hand
over hand, etc). Encourage the person to be as independent as possible.
7. Check the temperature of food before you begin. Feel the container, observing for
steam, to ensure the food is at an acceptable temperature.
8. Explain what foods are on the plate. For someone with a visual impairment, use the
clock description method (i.e., Your meat is at 12:00, vegetables are at 3:00," etc.).
9. Ask the individual what he/she wants to eat first.
10. Watch the individual to make sure food is swallowed before giving additional food or
fluids. Remind the individual to chew and swallow as necessary.
11. Offer liquids at regular intervals.
12. Engage the person in pleasant conversation while completing this task, but dont ask
questions that take too long to answer.
13. Do not rush the individual.
14. Once the meal is complete, ensure that you help the individual in wiping his/her face
and washing hands as necessary.
Practical Tips:
Be aware of how the individual may be feeling in regards to needing assistance. Allow
the person to make their own food choices; give options and respect preferences.
Be aware of any issues causing the individual to tire or get frustrated easily.
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Ensure that you are communicating with the individual about the pace in which you
are feeding or assisting him/her with eating.
Dont forget!
Dont do everything for the person just because it is faster for you. Only provide the
assistance that is truly needed.
Dont assume the individual likes every item that has been served.
Dont treat the person like a child. For example, do not wipe persons mouth with the
spoon.
Help him/her control chewing and swallowing by choosing the right foods (a diet
containing food with thick consistency, which is easier to swallow) such as:
o Soft-cooked eggs, mashed potatoes and creamed cereals
o Thickened liquids are often used.
At times dysphagia is temporary. A person who is temporarily ill may have difficulty
swallowing, which improves after recovery from illness.
Avoid changes. Seat the person at the same place for all meals.
Avoid excessive stimulation. Too much activity and noise often adds to confusion and
anxiety. Remove distractions, if possible, and gently refocus the person.
Meals should be ready to eat when the person is seated (e.g., meat is cut, bread is
buttered, etc.).
Call a person by a name he/she prefers. Achieve and maintain eye contact.
Use a calm voice; speak softly, slowly, clearly and face the person.
Keep communication simple. Use simple, short instructions such as pick up your
fork, put food on your fork, put the fork in your mouth.
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Poor or underdeveloped oral motor skills that do not permit adequate chewing or
swallowing.
Seizures.
Medication side effects that decrease or relax voluntary muscles, causing delayed
swallowing or suppression of the protective gag and cough reflexes.
Signs of choking:
Inability to talk.
Loss of consciousness.
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Snack food: popcorn, nuts, hard candy, chewing gum, and raisins.
Burritos.
Marshmallows
Hard Candy
Potato Chips
Tossed Salad
Meat Chunks
Raw Apple
Chewing Gum
Chicken on
bone
Corn Chips
Pretzels
Popcorn
Hard Beans
Thick Chewy
Bread
Tortilla Chips
Bagels
Grapes
Raw Carrots
Caramel
Raisins
Canned Fruit
Celery
Rice
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Distractions:
Inattention to eating.
Food stealing.
Diet:
Incorrect diet texture - liquids or food items not prepared in accordance with
prescribed diet.
Eating something with two or more diet textures, especially anything with a thin
liquid and a solid component, such as cereal and milk.
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Staff assistance:
Inadequate supervision.
Poor positioning.
Pay attention to the presentation of food. Set the table with tablecloth and/or
placemats.
Keep the table conversation positive and pleasant (Never say, If you dont eat, you
wont get dessert.").
7. Assistive devices
Encourage each person to eat as independently as possible. This supports a persons self
sufficiency, self-esteem and can save time. Sometimes a person may need to be fed or
guided through a meal. The following are general considerations:
Provide adaptive devices, such as a rocker knife, which allows one-handed cutting.
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Provide foods that do not require use of utensils (e.g., finger foods, soup in a mug).
Be consistent in placing food on a plate and on the table in specific order. For
example, potatoes are at the 3:00 oclock, meat is at 9:00 oclock position, for visually
impaired persons.
1. Definitions
Assistance means the help or aid necessary to complete a function or a task.
The Direct Care Worker may provide the assistance necessary for a person to take his/her
medication.
Direct self-care means a person is able to recognize danger, summon assistance, express
need, and make basic care decisions.
A person who is able to direct self-care can instruct the Direct Care Worker to assist by
opening the medication bottle; placing the medication in his/her mouth and providing a
drink of water.
Directed care services means programs and services, including personal care services,
provided to persons who are incapable of recognizing danger, summoning assistance,
expressing need or making basic care decisions.
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When providing directed care services, the Direct Care Worker may provide assistance
by taking direction from the responsible person, including providing the help necessary
for the person to take his/her medication.
Documentation means written supportive information.
The Direct Care Worker must keep documentation by recording the date and time of day
when assistance with medication self- administration was provided.
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3. What to document
Document that medications were administered according to the consumers instructions
or according to medication organizer date and time, as directed by the responsible
person.
A DCW cannot use professional judgment and cannot make decisions about
medications.
If the consumer does not know which medication is which, the DCW cannot help
figure this out.
If the consumer is confused about dosage/time etc., the DCW cannot help sort it out.
D. SKIN INTEGRITY
Any person who sits still for a long time may be at risk for skin problems. It is critical for a
DCW to routinely check a persons skin for any changes. Report any changes to your
supervisor.
Pressure Ulcers
Pressure ulcers are lesions to the skin. They are also called pressure sores or decubitus
ulcers. Pressure on the skin compresses tissue and can lead to the death of the tissue.
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Tailbone.
Heels.
Elbows.
Common sources of pressure are:
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c. Protect skin where bones protrude and where two skin surfaces rub together:
Protect the skin with clothing and special pads for elbows and heels. Cushions do
not replace frequent positions changes.
d. Protect fragile skin from being scratched: Keep fingernails (yours and the
persons) and toenails short. Long toenails can scratch a persons legs.
e. Protect skin from moisture and irritants: Keep skin dry. Be aware of moisture
sources, including baths, rain, perspiration, and spilled foods and fluids. Watch for
skin irritation from detergent residues left in clothing and bedding.
f. Watch for allergic reactions (rashes) from health and personal care products:
Some persons, for example, are allergic to incontinence pads.
g. If you see an area is reddened, provide a light massage around the reddened
area (not on it), to increase circulation to the area.
2. Bathing
Bathing provides many benefits:
Cleansing and removing wastes from the skin.
Stimulating circulation.
Providing an opportunity to observe the skin and an opportunity to connect with the
person.
Some individuals may be able to bathe without help. Some may need assistance
occasionally, and others may need help all of the time. Encourage as much
independence as possible.
How often a person bathes will probably be between you and the person. A minimum of
twice a week is recommended. You should realize that every time an individual bathes
he/she washes off natural oils, making the skin drier. The persons bathing patterns, skin
type, recent activities and physical condition will all be factors in deciding how often a
person bathes.
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Find out what skin care products the person uses and gather all bath items needed
before starting.
Allow or assist the person to use the toilet prior to bathing, if needed.
When providing total assistance with the bath or shower, always start at the head
and work down to the feet.
If assisting to dry the person, pat the skin dry to avoid irritating or breaking the skin.
Assist with or bathe the skin whenever feces or urine touch the skin.
Place a mat on the shower floor unless there are non-skid strips or a non-skid
surface.
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Drain the tub before the person gets out; cover the persons upper body with a
towel for warmth.
Verify and always provide the amount of supervision the person requires.
Stay within hearing distance of the shower or tub if the person can be left alone by
waiting outside the shower curtain or door.
3. Hair Care
Routine hair care involves washing, combing, drying and styling. It can be a very tiring
task, even for persons who are independent in most areas. A person may enjoy going to
a hair salon or barbershop, or having you assist. Some hairdressers will make house calls,
too.
A shampoo can be given in the tub or shower, at the sink, or in bed. Always consider the
person's wishes when determining a style. It should be easy to care for and appropriate
for the person. The person's own styling equipment (e.g., styling brush, curlers, and
hairpins) should be used.
If you assist with hair care, have the needed supplies ready:
Caution: If the person has an eye disorder or has had recent eye surgery, consult a health
care professional before proceeding with a shampoo. Moving the head into various
positions might cause increased pressure on the eye. You may need to avoid this.
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4. Dressing
The key to assisting with dressing, as with any of the personal hygiene and grooming
tasks, is for a DCW to allow a person to be as independent as possible, even if the person
dresses slowly.
Dont assume a person wants to wear items of clothing that someone else may have
chosen for them.
Be aware of any issues that could cause the person to get tired or frustrated easily.
Encourage the person to wear clothes with elastic waistbands and Velcro closures.
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Dont forget!
Encourage the person to be as independent as possible.
Only provide the assistance needed dont do everything for the person just because
it is faster for you.
If the person has a stronger and a weaker side, put the clothes on the weaker arm
and shoulder side first, then slide the garments onto the stronger side. When
undressing, undress the strong side first.
5. Shaving
For most men, shaving is a lifelong ritual, and they are able to perform this task despite
impairments. The act of shaving, as well as the result, usually boosts morale. A male
person should be allowed to shave himself unless it is unsafe for him to do so.
A female person may desire to have legs, armpits or facial hair shaved.
An electric razor is easiest and safest to use. Persons who have diabetes or who take
anticoagulants should use an electric shaver. After shaving with the electric shaver, rinse
the face with warm water or place a warm wet washcloth over the face and pat dry. If
the individual desires, apply after-shave lotion.
6. Nail Care
Nail care for fingers and toes prevents infection, injury, and odors. Hangnails, ingrown
nails, and nails torn away from the skin may cause skin breaks. Long or broken nails can
scratch the skin or snag clothing. Nails are easier to trim and clean right after soaking or
bathing. Nails are trimmed with nail clippers, not scissors. Some agencies do not allow
their staff to clip nails because using clippers can cause damage to surrounding tissue.
Supplies
Wash basin with warm water.
Nail clippers (not scissors).
Orange stick, emery board or nail file.
Procedure
1. Arrange items next to the person. Allow the person to soak nails for 10-20 minutes or
do the procedure after a bath. Clean under the nails with an orange stick.
2. Clip nails STRAIGHT ACROSS with the nail clippers if allowed to do so. Shape
fingernails with an emery board or nail file.
3. Apply lotion or petroleum jelly to hands and feet.
4. Clean and return equipment and supplies to their proper place. Discard disposable
items.
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Schedule soaks on non bath days. The person can soak feet while sitting and doing
grooming tasks or while watching TV. The foot soak should not last more than 20
minutes.
Provide a basin of warm water and mild soap.
Remind the person to exercise feet while soaking. Give step-by-step instructions:
Wiggle the toes, stretch the feet, rotate the ankles clockwise, then counterclockwise,
flex and extend the toes and ankles
Pat feet dry. Dry thoroughly between the toes.
Examine the feet. Look carefully, especially if the individual limps, resists walking or
paces (increased friction may cause blisters or pressure sores). If any lesions are
noted contact your supervisor for further instructions.
Apply lotion to dry, cracking skin. Use a lotion containing lanolin or mineral oil.
Clean and return equipment and supplies to their proper place. Discard disposable
items.
7. Assistive Devices
Falls in the bathroom are the most common household accident. Wet, soapy tile, marble,
or porcelain surfaces in bathrooms can be very slippery. A seat designed for the bath or
shower and grab bars allow the person to enjoy safely bathing in comfort. Seats come in
different sizes and styles. In any case, look for one that is strong, stable, and has rubber
caps on the legs to prevent slipping.
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Bath Stool
Economical and lightweight, the bath stool is suitable for a person of slight to medium
build. The rubber-capped legs prevent slippage and, with no backrest, allow for easy
access to a persons back. The bath stool is ideal for narrow tubs and can easily be stored
when not in use. However, its small base contributes to poor stability.
Bath Chair
The bath chair is good for a person with poor back strength and a bigger build (some
seats can support up to 400 pounds). While stability is enhanced by rubber-capped legs
and a wide base, the bath chair may not fit inside a narrow tub. The backrest hinders
easy access to a persons back and other parts of the body.
Transfer Bench
A bench is suitable for those who have difficulty lifting their legs in and out of a tub. The
long stationary seat remains partly inside and outside the tub. A person sits down
outside the tub, and moves inside by sliding the body across the seat. The suction cups
on the height adjustable legs (the inside of the tub is higher than the outside) prevent
slippage.
Hand Held Shower Heads
Standard shower heads can be replaced with a hand-held model. This shower head
allows an individual to hold the water at the level needed in the shower.
Grab Bars
Installing grab bars in the tub and shower can help a person get in and out more easily
and reduce risk of falling.
A grab bar near the toilet can give support when sitting down and standing up. If more
support is needed, there are a variety of railings that can be added to the toilet itself.
Raised or Elevated Toilet Seats
Raised toilet seats assist persons who have difficulty bending or sitting by raising the
height of the toilet seat to a more comfortable and convenient height. There are a
variety of raised toilet seats to choose from. Some have armrests which provide a sturdy
grabbing platform to help with transfers and others are specifically designed for people
who are recovering from hip replacement or leg fractures. Some can be attached to the
toilet while others are freestanding.
The person must be able to have both feet flat on the floor when sitting on the seat, or it
is too high.
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F. ORAL HYGIENE
Good oral hygiene prevents sores and bad breath and keeps mucous membranes from
becoming dry and cracked. Poor oral hygiene can contribute to poor appetite, and the
bacteria in the mouth can cause pneumonia. Inflamed gums also set up an inflammatory
process that puts a strain on the heart and decreases resistance to infections. Encourage
persons to brush their teeth daily, especially at bedtime. Electric tooth brushes or brushes
with larger or longer handles promote self-care.
Providing proper oral hygiene for an individual that is unable to care for his or her own teeth
is an important role for a Direct Care Worker. Proper tooth brushing techniques help prevent
conditions such as gingivitis, tooth decay and tooth abrasions, a condition in which the tooth
is worn away. If you assist a person with oral hygiene, examine the mouth on a regular basis
for signs of redness, swelling, or bleeding. A dentist should check any red or white spots or
sores that bleed and do not go away within two weeks.
Protective gloves.
Emesis basin.
Disposable cup.
Water or mouth rinse.
Protective covering for clothing.
Description of procedure
1. Gather all needed materials.
2. Provide an explanation of what will occur prior to starting the process and continue
throughout.
3. Place the person in a seated (minimum of 60 degrees) or standing position prior to
beginning.
4. Place a protective covering over the person's clothing.
5. Wash hands and apply gloves before brushing the persons teeth.
6. Apply water and a small amount of toothpaste to the toothbrush.
7. Brush all surfaces of the teeth and gum line before brushing the inside of the teeth. It is a
natural reaction to bite down on whatever is placed in the mouth. To help avoid the bite
reflex, do not insert the toothbrush to the inside of the mouth until later in the process.
Principles of Caregiving Developmental Disabilities (Participant Guide)
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8. Offer the person the opportunity to rinse and spit into an emesis basin as needed. If the
person cannot independently rinse, turn the person to one side to allow the liquid to run
from the persons mouth into a folded cloth.
9. Rinse the toothbrush periodically and apply another small amount of tooth paste as
needed.
10. Clean the inside and outside teeth.
Brush a small group of teeth at a time with a slow gentle motion for approximately
20 brush strokes or 10 seconds.
Continue above steps until all outside and inside upper and lower premolars and
molars have been brushed.
Clean the inside surfaces of the upper and lower front teeth, use the tip of the
toothbrush in a sweeping motion and move the toothbrush away from the gum line.
11. Upon completion, clean and dry the area around the persons mouth and remove
protective covering.
12. Dispose of soiled linen and trash.
13. Remove and dispose of gloves.
14. Wash your hands.
Practical tips
Stand behind the person so you are looking down on his/her mouth. This will allow
easier access and a better view of the persons mouth.
Brush all three areas of the teeth (outside, inside and top).
If the person is not able to spit out water, use an oral swab instead of a toothbrush.
Dont forget!
Thoroughly clean the toothbrush after each use.
Utilize universal precautions and infection control measures through the process.
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1. Urinary incontinence
Urinary incontinence is the involuntary leakage of urine from the bladder.
Common causes for bladder problems:
Nerve changes. The person does not recognize that the bladder is full.
Memory loss. A person may forget where the toilet is or how to use it.
Stress or fatigue.
Infection.
Medications.
Alcohol.
Control of incontinence
Establish toileting schedule every two hours. Schedule trips to bathroom 10-15
minutes before the typical time incontinence usually has occurred in the recent past.
Emptying the bladder before the urge allows more time to get to the bathroom.
Identify assistance you can provide. For example, if access to the bathroom is a
contributing factor, list steps you need to take to correct the situation (e.g., provide
the person with a urinal or commode in the room, and label the bathroom door so
that a confused person can identify it). Additionally, include interventions that may
help a person (e.g., positioning, increased fluid intake, and exercise). The following
practices are safe in most situations:
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2. Incontinence pads
Incontinence pads and briefs help manage bladder and bowel incontinence. They are
very absorbent and protect clothing. There are many different types of pads and briefs
on the market. If the person is unhappy with a certain type, try others before giving up.
Please do not use the term diaper with adults.
In assisting with changing a pad or brief, the DCW should gather supplies (new pad,
plastic bag, and cloth or disposable wipes for cleansing the skin). The DCW should put on
gloves and assist in removing the old pad as necessary. Put the soiled pad into the plastic
bag. Assist the person in cleansing the peri area (the skin needs to be cleansed of urinary
and fecal enzymes that will break down skin). Place any soiled disposable wipes in the
plastic bag. Assist in applying a new pad. Peel off gloves and toss into plastic bag. Tie bag
and take to outside trash. Wash hands.
3. Ostomy care
An ostomy is a surgical opening in the abdomen through which waste material
discharges when the normal function of the bowel or bladder is lost. An ileostomy is an
opening from the small intestine (ileum portion), and a colostomy is an opening from the
large intestine (colon). Both types discharge feces. A urostomy is an opening to bypass
the bladder and discharge urine.
The care and management of the ostomy depends on what type it is. Typically, the
person wears a plastic collection pouch. It is attached to the abdomen at all times to
protect the skin and collect the output. When a new pouch is needed, the skin is
cleansed with soap and water, a protective skin barrier may be applied, and a new pouch
is applied (may have to be precut to fit the stoma opening). The pouch is emptied at the
persons convenience. Again, how the pouch is emptied will depend on the type of
ostomy and the supplies used. Some colostomies can be controlled by irrigation (enema)
and only require a small gauze pad or plastic stick-on pouch to cover the stoma between
irrigations.
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There are different types of ostomy supplies on the market and each individual will have
individualized needs for ostomy care depending on the type of ostomy and the size of
the stoma (opening) and personal preference. Notify your supervisor if ostomy care is
needed.
H. TRANSFERRING
Some persons need assistance with transfers. Examples are getting in and out of bed or a
chair. There are different techniques and tools for the DCW to use.
Levels of assistance in transfers
Maximum assist
Mechanical lift.
Moderate assist
Gait belt with person who is 50% or more weight bearing.
Verbal cues with moderate physical assist.
Minimum assist
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Explain each step of the transfer and allow the person to complete it slowly.
Verbally instruct the person on the sequence of the transfer. (e.g., "Move to the front of
the chair," etc.).
When assisting in the transfer of a person do not grab, pull or lift by the persons arm
joints (elbows, shoulders, wrists) as this can cause a joint injury.
Know your limits: Dont transfer anyone heavier than what you can handle.
If the person is unable to stand or is too weak to stand, the DCW should use a
mechanical lift for transfers. If this is not in the service plan or you do not know how to
use a mechanical lift, ask your supervisor for instructions on what to do.
The individual who needs support depends on the DCW for hands-on assistance. If
the DCW does not take care of his/her back with the correct body mechanics, the
DCW will not be able to provide that assistance.
Not using correct body mechanics puts the safety of the person and DCW at risk.
Some injuries cause permanent disabilities.
Just as lifting, pushing, and pulling loads can damage your back so can bending or
reaching while working in an individuals home. As a DCW, you may have witnessed
firsthand the pain and misery a back injury can cause. The good news is that you can
learn some simple ways to reduce the risk of injuring your back.
Body mechanics principles that play an integral part of this section are:
Proper footwear: DCWs should always wear proper footwear. Wear closed, non-slip
shoes.
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Center of gravity over base of support: It is important for the DCW to be aware of
center of gravity over base of support in working with a client. Usually a persons
center of gravity is right behind a persons navel (belly button). A good base of
support is being in a standing position where the feet are slightly apart and knees
slightly bent.
Principles of body leverage: Using leg and arm muscles is important, but so is
applying body leverage. Mirror posture of the client. Use body as a whole and not just
one part.
Persons with recent surgery or incisions (within the last 6-8 weeks) in the torso area.
Individuals with ostomy (e.g. a colostomy), G-tube, hernias, severe COPD, postsurgical incisions, monitoring equipment, tubes or lines that could become
compromised by the pressure.
A pregnant person. Applying a gait belt to a pregnant woman could cause injury to
the unborn child.
If the DCW determines the person cannot safely use a gait belt, the DCW should contact
the supervisor for instruction on agency specific policy and procedures.
Description of procedure
1. Tell the person what you are going to do.
2. Position the person to make application of the belt easier.
The person needs to move forward and sit on the edge of the
chair.
3. Place the gait belt around the persons waist, above the
pelvic bone and below the rib cage. Always place the gait
belt on top of clothing, and for females make sure breast
tissue is above the belt.
4. Pass the metal tip of the belt end through the teeth of the buckle first and then
through the other side of the buckle.
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5. Adjust it so it is snug, but not uncomfortable for the person. You should be able to
slip your open flat hand between the belt and the person.
6. Tuck the excess end of the belt through the waist band.
7. The strap should lay flat across the buckle.
8. ALWAYS verify proper closure before use.
9. ALWAYS grasp the transfer belt from underneath.
10. Remove the gait belt when not in use, or loosen it.
Practical Tips:
It is important that you ask permission before applying a gait belt because you are
about to invade the persons personal space. Maintain persons rights by informing
him/her of all procedures prior to actions.
Gait belts come in various lengths; use an appropriate size for the person.
Belts with padded handles are easier to grip and increase security and control.
Use a rocking and pulling motion rather than lifting when using a belt.
DCW should walk slightly behind the person with a hand under the bottom of the
belt.
On some gait belts, the seam and label will be on the outside, on other belts it is on
the inside. Dont assume that the manufacturers label is on the inside be sure to
start putting the end of the belt through the teeth first.
Dont forget!
Apply gait belt over clothing, NEVER apply to bare skin.
Use good body mechanics when transferring a person with a gait belt.
Description of procedure
1. Tell the person what you are planning to do.
2. If possible, raise or lower the height of the bed to prevent a position that could strain
the DCWs back.
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3. Have the person roll onto their side, facing you, elbows bent, knees flexed.
4. Place one arm around the persons shoulders (not the neck) and one over and around
the knees.
5. Instruct person to use the forearm to raise up and the opposite hand to push up to a
sitting position while you support their back and shoulders with left hand.
6. With your hand behind the persons knees, help them swing their legs over the side
of the bed with one fluid motion. Assist them in moving to the edge of the bed if
necessary.
7. Allow person to sit on the edge of the bed for a minute or two. Ensure the person is
oriented and stable before attempting to stand
8. Assist with putting on non-skid footwear (sneakers, slippers, tread socks are good
choices).
9. If bed was raised or lowered, make sure to adjust to a height in which the persons
feet can touch the floor comfortably
10. Instruct person to place feet flat on the floor.
11. Assist the person to stand. The DCW should keep one hand on the persons elbow
and the other behind the persons back.
Practical Tips
Be sure to have supplies ready. Do not leave the person on the edge of the bed while
you go find slippers or a robe.
Remember to support limbs and back during procedure.
BE OBSERVANT! It is common for the blood pressure to drop when going from a
prone to a sitting position, causing light-headedness or dizziness. Watch the person
for changes in condition, such as color changes, respiratory changes, and other signs
of distress.
Use good body mechanics when turning a rolling, moving, and standing. Protect your
back.
Encourage the person to help as much as he possibly can; this helps maintain
independence.
Dont forget!
Dont forget to lower the bed if a mechanical bed is being used.
Do not pull the person by arms, hands, wrists etc. Support back and knees to
prevent injury.
Do not let the person place his hands/arms around your neck while you assist.
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Description of procedure
Note: Person is 50% or more weight bearing (moderate assist)
1. Ensure the person can safely wear a gait belt.
2. Explain the gait belt procedure to the person.
3. Ask the persons permission to use the gait belt. Explain the belt is a safety device
and will be removed as soon as the transfer is complete.
4. Tell the person what you are going to do.
5. Lock the wheels of wheelchair.
6. Put the footrest in the up position and swing the footrest to the side or remove.
7. Take off the armrest closest to the chair (or drop armrest if possible).
8. Place chair at a 45 degree angle to the wheelchair.
9. Have the person move to the front of wheelchair seat.
10. Use gait belt secured around persons waist to assist him/her out of the wheelchair
(refer to gait belt skill).
11. Foot Placement (depending on the clients disability or preference):
Place both of your feet in front of the clients feet with your toes pointed
outward.
Place one foot slightly in front of the other one. The foot in front will be placed
between the clients feet.
12. Have the person either hold onto your shoulders or arms, not around your neck!
13. Grasp the gait belt on both sides with fingers under belt.
14. Bend at knees and hips. Lift with legs, not back.
15. Assist the person to a standing position, mirroring posture of person.
16. Have the person stand for a minute, shifting weight from one foot to other.
17. Pick up your feet and move them facing the chair as the person takes baby steps to a
standing position in front of chair.
18. Ask the person if he/she feels the chair seat on the back of his/her legs.
19. Have the person put his/her hands on the armrests.
20. Assist the person to a seated position, mirroring the persons posture.
Principles of Caregiving Developmental Disabilities (Participant Guide)
Revised April 2011
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Practical Tips:
DCW should always use proper foot wear (closed, non-slip, flat shoe).
Dont transfer a person who is too heavy for this type of body transfer.
Dont forget!
Special Note:
Before you begin working with a person, familiarize yourself with the support plan
and expectations/requirements. Contact your supervisor for clarification.
Ensure the person can safely wear a gait belt. See application of gait belt for
procedure and contraindications.
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Supplies
Gait Belt and/or other walking aids like a cane or a walker.
Non-slip, properly fitting footwear.
Description of Procedure
1. Communicate procedure/actions to person before you begin.
2. Apply non-skid, properly fitting footwear.
3. Apply gait belt (see procedure for gait belt application).
4. Make sure that the person has his feet firmly on the floor.
5. Use an underhand grasp on the belt for greater safety.
6. Have the persons walking aid readily available if required.
7. Walk behind and to one side of the person during ambulation;
hold on to the belt from directly behind him. Be aware to
support weaker side if applicable.
8. Right side: you should be standing between 4 and 5 oclock.
9. Left side: you should be standing between 7 and 8 oclock.
10. Let the person set the pace, and walk in step with the person, maintaining a firm
grasp on gait belt.
11. Watch for signs of fatigue.
Ambulation with a walker
When assisting a person with ambulation when using a walker, it is
imperative that the person stay inside the frame of the walker. Make
sure it has been properly fitted for the individual. The DCW should
always walk on the persons weak side to provide additional support
as needed.
Special Note: In the instance a person does collapse or loses his/her
footing, it is acceptable to ease the person gently to the floor. The
DCW should not try to carry the person, hold him up or catch him if he
starts to fall.
Practical Tips:
Communicate expectations with person at all times.
Encourage the person to assist as much as possible.
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Dont forget!
Keep a firm grasp on gait belt.
Dont assume that once the person is up and moving, she will continue to be stable.
Always be prepared for a fall.
People who cannot change position need to have the DCW change his/her position in
bed or in a chair/wheelchair at least every two hours. (See also the section on skin
care.)
Preventing contractures
A contracture is a stiffening of a muscle due to inactivity. When muscles get smaller and
shorter, they cannot be used properly. Contractures can be painful and difficult to treat.
Tips for preventing contractures:
Encourage the person to sit upright.
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Positioning in Bed
Supine Position, on the back, with
pillows used for support; heels off
the bednote pillow under head is
placed under shoulders and under
ankles, calves and knees.
Incorrect
Wrong
correct
Right
correct
or
Right
Incorrect position
for front wheels
Correct position
for front wheels
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Description of Procedure
1. Explain to the person what steps you are going to do to
reposition him.
2. Have wheel chair locked with caster wheels in forward
position (this can be accomplished by moving the
wheelchair backwards. Then the front caster wheels go
forward, which sets the wheelchair to have a strong base
of support.
3. Move foot rest to side if applicable.
4. Stand in front of the person with the left leg of the person
between your legs. Have the person lean forward with the person putting his/her
head above your left hip. This places most of the persons weight on his/her right
buttock side. Your left arm should come across the persons
back to provide stability.
5. Place your right arm under the thigh of the persons left leg
while placing slight pressure against the persons left knee
by pressing against it with your leg. (It is best to use the
wide area above your knee to press against the persons
knee.) With a fluid motion, use your entire body to gently
push the person toward the back part of the wheelchair.
6. Let the person sit up, and then do the same steps to the
other side of the person that needs to be repositioned. You
might need to do this several times (both left side and right
side) for the correct alignment of the person in the wheelchair.
Practical Tips
Make sure the persons weight is on the side opposite the side that is to be repositioned.
Prepare for this technique by repositioning yourself in a chair: Sit on the edge of a
chair and move yourself backward without the use of your hand. This motion of
backing up in a chair (first one side, then the other) is used for the technique of
repositioning.
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Dont forget!
Always use proper body mechanics. Poor body mechanics can injure both DCW and
person.
Do not rush the procedure; you may need to do this procedure a couple of times to
get the person all the way back in the chair.
DO NOT lift person over the back of the handles of the wheelchair
Note: When doing this procedure with someone in a chair, make sure the back of the
chair is secured so that the chair does not move when repositioning the person.
Practice Scenario
John, who is quadriplegic and uses a mechanical lift to be transferred into the
wheelchair, regularly needs to be repositioned in the wheelchair to have a good sitting
alignment. Demonstrate how you would reposition John if he is sliding out of the
wheelchair.
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4. Assistive Devices
Walkers and wheelchairs are common devices to help individuals with mobility. The DCW
should be familiar with the devices and know how to use them safely.
Walkers
Walkers are popular: almost two million people in the U.S. use them. Walkers are helpful
for people with arthritis, weak knees or ankles, or balance problems. Able to support up
to 50% of a persons weight, walkers are more stable than canes.
Types of walkers
The standard walker (no wheels, see photo on p. 41) is the basic type most often used in
therapy. To operate, a person lifts the walker, moves it forward, and puts it back down
with each step. Because they require lifting, extended use may cause strain on the wrists,
shoulders, and arms.
With a wheeled walker (2 wheels), the user merely pushes the two-wheeled walker
forward. No lifting is necessary, so the walking style is more natural.
Two-wheeled walkers have automatic brakes that work when you push down on the
walker. Some have auto-glide features that allow the rear legs to skim the surface.
Many standard and wheeled walkers fold for easy storage or transport.
Rolling walkers (3 or 4 wheels) require less energy. Gliding over carpets and thresholds is
easier, and they may make turning easier. Rolling walkers often have hand brakes. All are
heavier than rigid or folding walkers. Many wheeled walkers do not fold and may be
difficult to transport.
Effective walker use
Walker height is best when the arm bends at the elbow in a 20 to 30 degree angle.
The top of the handle of the walker should be at the same height as the bend of the
persons wrist.
To prevent tripping or falling, the person should:
Always look ahead, not at the feet.
Walk inside the walker (avoid pushing walker to far ahead as if it were a
shopping cart).
Use walkers only in well-lit areas. Cluttered and crowded areas, throw rugs,
and wires running across the floor should be avoided.
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Wear appropriate footwear. Properly fitting shoes with rubber soles are best.
Loose fitting footwear such as slippers, or slippery-soled shoes, should be
avoided.
Avoid using the walker on stairs.
Small rooms, such as bathrooms, may prevent safe walker use. A solution is to install
grab bars. With a wheeled walker, you may be able to reverse the wheels. Then the
wheels are on the inside of the walker, saving 3-4 inches of space.
Wheelchairs
Most common is the standard wheelchair. It can weigh over forty pounds. A light
weight wheelchair (20-25 pounds) is easier to transport or store.
Power wheelchairs (electric) have batteries. They require little strength to operate. They
can be heavy and large and probably require a van for transportation.
Scooters are also electric. A scooter looks like a chair mounted on a platform with
wheels.
Wheelchair Accessories
Transfer boards let a person move from the wheelchair to another seat or bed
without standing.
Safety flags make the person or chair more visible. It is a red flag on a long pole.
Baskets and bumpers are available for some wheelchairs.
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